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A rinossinusite é uma doença potencialmente grave, e pode apresentar sérias complicações. As orbitárias são as mais freqüentes, graças às peculiaridades anatômicas desta região, podendo levar à morte em 5% dos casos. Os sintomas variam desde sinais flogísticos periorbitários até proptose do globo ocular, oftalmoplegia e amaurose. OBJETIVOS: Proposição de uma nova classificação para as complicações orbitárias das rinossinusites agudas. MATERIAL E MÉTODO: Revisão de TC e prontuários de 83 pacientes atendidos no Hospital das Clínicas da FMRP-USP, entre os anos de 1995 a 2005, com rinossinusites agudas complicadas. RESULTADOS: Após a revisão das TC e história clínica, foram identificadas em sessenta e seis pacientes, três tipos de complicações orbitárias: celulite orbitária (46,9%), abscesso subperiosteal (40,9%) e abscesso orbitário (12,1%). Dezessete foram considerados como infecções palpebrais, ficando excluídos da nova classificação. CONCLUSÃO: As classificações das complicações orbitárias existentes na atualidade, como a de Chandler, não levam em conta os parâmetros anatômicos da órbita e tornaram-se obsoletas com o advento da TC. Este estudo propõe uma classificação mais concisa e objetiva que ajude a guiar a conduta terapêutica de forma mais linear.

There is still controversy on which is the best method to collect the secretion directly from the middle meatus or maxillary sinus in patients with chronic rhinosinusitis.Aim: To evaluate the prevalence of bacteria in patients with chronic rhinosinusitis and compare the suction trap collector to direct aspiration attached to a syringe for the microbiological analysis of these secretions.Materials and Methods: Prospective study involving 31 patients who underwent endoscopically guided maxillary secretion aspiration by two different methods (aspiration with the collector tube “suction trap” and aspiration with the use of a catheter connected to a syringe), to determine the microbiological diagnosis and to compare the two methods used.Results: microorganisms grew samples collected from 55% of the 31 patients. The most frequent bacteria were S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria. The results from cultures were similar between the two methods in 71% of patients.Conclusion: S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria make up the main flora in the maxillary sinus of the patients. There was good correlation between the microbiological results obtained by using a catheter attached to a syringe and the “suction trap” nasal collector.

There isn't definitive and consistent data concerning the distribution of bacterial species in patients with Chronic Sinusitis (CS). The variability of the results from studies in CS may be due to the different techniques used as collection method, variations in culture methods, previous antibiotic use, and difficulty in distinguishing bacterial flora from pathogenic agents.Study designClinical prospective.AimTo identify the incidence of microorganisms in patients with CRS by growing bacteria from the secretion of the maxillary sinus.Patients and MethodsCross-sectional study in 62 patients that had undergone FESS for treatment of chronic sinusitis; cultures from the maxillary sinus were obtained.Results62 samples, 33 (53.2%) had no growth; 29 (45.2%) counts of aerobic bacteria; one case (1.6%) of fungus growth; we did not find anaerobic bacteria. Pseudomonas aeruginosa was the one more frequently found - 8 samples (27.6%), Staphylococcus aureus and Staphylococcus epidermidis in 4 samples each; Streptococcus pneumoniae in 3 samples (10.4%); other Gram negative agents in 17 samples (31%).ConclusionIn the present study we concluded that Pseudomonas aeruginosa, other Gram negatives bacteria and Staphylococcus spp were the representatives of the bacterial flora found in the paranasal sinuses of patients with CS.